| NPI | 1972344554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA KOHLS Owner 715-205-0939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care |
| Enumeration Date | 2024-06-05 |
| Last Update Date | 2024-08-28 |